MSK patho and NP reviews

Question 1

WEB GOUT

During a home health visit you are helping a patient with gout identify foods in their pantry they should avoid eating. Select all the foods below the patient should avoid:
A. Sardines
B. Whole wheat bread
C. Sweetbreads
D. Crackers
E. Craft beer
F. Bananas

Answer 1

The answers are A, C, and E. A patient with gout should avoid foods high in PURINES. These include most red meats, organ meats (liver, kidneys, sweetbreads), alcohol (especially beer), seafood and sardines.

Question 2

WEB GOUT

Gout is a type of arthritis that occurs due to the accumulation of ____________ in the blood that causes needle-like crystals to form around the joints.
A. purines
B. creatinine
C. uric acid
D. amino acids

Answer 2

The answer is C. In gout, uric acid accumulates in the blood, which leads to the formation of needle-like crystal around the joints.

Question 3

WEB GOUT

Identify which patient below is at MOST risk for developing gout:
A. A 56 year old male who reports consuming foods low in purines.
B. A 45 year old male with a BMI of 40 who reports taking hydrochlorothiazide and aspirin.
C. A 39 year old female hospitalized with bulimia that has a BMI of 24.
D. A 27 year old female with ulcerative colitis.

Answer 3

The answer is B.
Risk factors: age, male, obesity, alcohol

Question 4

WEB GOUT

A patient is post-op from surgery. The patient has a history of gout. While performing a head-to-toe assessment, you assess the patient for signs and symptoms of gout. As the nurse, you know that gout tends to start at what site?
A. Elbow
B. Big toe
C. Thumb or index finger
D. Knees

Answer 4

The answer is B.
Most patients tend to have an acute attack of gout that begins in the big toe. Remember that patients who have a history of gout or who are experiencing a hospitalization (due to the physical stress on the body) are at risk for an acute gout attack. Therefore, the nurse should assess the patient for this during the head-to-toe assessment.

Question 5

WEB GOUT

A 75 year old male is admitted for chronic renal failure. You note that the patient has white/yellowish nodules on the helix of the ear and fingers. The patient reports they are not painful. As you document your nursing assessment findings, you will document this finding as?
A. Nodosa
B. Keloid
C. Dermoid
D. Tophi

Answer 5

The answer is D.
Tophi or the accumulation of crystalline deposits – bony and connective tissue

Question 6

WEB GOUT

You’re developing a nursing care plan for a patient with gout present in the right foot. What specific nursing interventions will you include in this patient’s plan of care? Select all that apply:
A. Encourage fluid intake of 2-3 liter per day.
B. Provide patient with foods high in purine with each meal daily.
C. Place patient’s right foot in a foot board while patient is in bed.
D. Administer PRN dose of Aspirin for a pain rating greater than 5 on 1-10 scale.
E. Apply alternating cold and warm compresses to right foot as tolerated by the patient daily.

Answer 6

The answers are A, C, E.
FROM OSMOSIS:
- You explain that and staying hydrated is also important for managing gout (A)
- Next you discuss the importance of limiting foods that are high in purines which include red meats, seafood, soda, alcohol and aged cheeses. B IS WRONG.
- Next, you encourage Mr. Symanski to elevate his foot and advise him to keep his toe open to air. (C)
- hyperuricemia can also occur when there’s reduced excretion of uric acid by the kidney, which can result from dehydration, diabetes, chronic kidney disease, and medications like thiazide diuretics or aspirin. naxoproxen will be prescribed instead (alt NSAID). D IS WRONG
- E is to relief pain and inflammation

Question 7

WEB GOUT mEDS

A patient is ordered by the physician to take Allopurinol (Zyloprim) for treatment of gout. You’ve provided education to the patient about this medication. Which statement by the patient requires you to re-educate them about this medication?
A. “This medication will help relieve the inflammation and pain during an acute attack.”
B. “It is important I have regular eye exams while taking this medication.”
C. “I will not take large doses of vitamin C supplements while taking this medication.”
D. “Allopurinol decreases the production of uric acid.”

Answer 7

The answer is A.
Allopurinol is used to PREVENT gout attacks (debilitating~)….not treat an acute attack.
NSAIDs and Colchicine are best for treating the inflammation and pain during a gout attack.
Allopurinol can cause vision changes, therefore the patient should receive annual eye exams along with avoiding large doses of vitamin C due to the risk of renal calculi formation

Question 8

WEB GOUT meds

During the 1000 medication pass, your patient reports to you that he is having muscle pain and tingling in his fingers and toes. You note that the patient also has a grayish color to his lips. You immediately notify the doctor. In addition, you would hold which medication that is scheduled to be administered at 1000?
A. Ibuprofen
B. Prednisone
C. Colchicine
D. Aspirin

Answer 8

The answer is C.
FROM NOTES
Side effects: skin rash, nausea & vomiting, diarrhea, fever, sore
throat, stomach pain, dark urine, jaundice
‘
‘
The signs and symptoms presenting in this patient are classic signs of Colchicine toxicity. Therefore, the nurse should not administer Colchicine. This medication can also cause GI upset and neutropenia.

Question 9

WEB GOUT meds

It is important a patient with gout avoid medications that can increase uric acid levels. Which medication below is NOT known to increase uric acid levels?
A. Aspirin
B. Niacin
C. Cyclosporine
D. Tylenol

Answer 9

The answer is D.
Options A, B, and C increase uric acid. Option D does not.

Question 10

WEB GOUT

You are providing a free clinic seminar to participants about gout. Which statement by a participant about the occurrence of gout is correct?
A. “Gout attacks tend to awake the person out of their sleep in the middle of the night.”
B. “The pain felt with gout tends to be intense during the first 30 minutes.”
C. “It is best for a patient experiencing gout to tightly bandage the affected extremity.”
D. “Typically acute gout attacks are predictable and tend to occur once or twice a week.”

Answer 10

The answer is A.
This is the only correct statement about gout.
Option B is wrong because the pain felt with gout tends to intensify within 4-24 hours (not 30 minutes).
Option C is wrong because any type of pressure (even the pressure of bed linens) can majorly increase the pain felt with gout.
Option D is wrong because gout attacks come on suddenly and may only occur once and tend to have several months or a year between attacks.

Question 11

textbook

. Which teaching point will the nurse provide to a patient
with a new prescription for alendronate (Fosamax)?
1. Take the medication with a full glass of water 30
minutes before breakfast.
2. Take the medication with a small snack or meal
containing dairy.
3. Take the medication immediately before bed.
4. Take the medication with a calcium supplement.

Answer 11

Answer: 1
Rationale: Alendronate (Fosamax) should be
taken on an empty stomach with a full glass of water,
and the patient should remain upright for a minimum
of 30 minutes to prevent esophageal irritation. Options
2, 3, and 4 are incorrect. The drug should not be taken
with food and should be taken early in the day

Question 12

textbook

Which assessment findings in a patient who is receiving calcitriol (Calcijex, Rocaltrol) should the nurse immediately report to the healthcare provider?
1. Muscle aches, fever, dry mouth
2. Tremor, abdominal cramping, hyperactive bowel
sounds
3. Bone pain, lethargy, anorexia
4. Muscle twitching, numbness, and tingling of the
extremities

Answer 12

Answer: 3
Rationale: Toxicity from calcitriol (Calcijex, Rocaltrol) includes symptoms of hypercalcemia and bone pain, anorexia, nausea and vomiting, increased
urination, hallucinations, and dysrhythmias. Options
1, 2, and 4 are incorrect. Muscle aches, fever, and dry
mouth are not related to calcitriol toxicity, and other
causes, including infection, should be investigated.
Tremor, abdominal cramping, hyperactive bowel
sounds, muscle twitching, numbness, and tingling of
the extremities are signs of hypocalcemia. Calcitriol
may cause symptoms of hypercalcemia

Question 13

textbook

The patient who is receiving allopurinol (Lopurin)
for treatment of gout asks why he should avoid the
consumption of alcohol. The nurse’s response is based
on the knowledge that the use of alcohol along with
allopurinol may result in which of the following?
1. It significantly increases the drug levels of
allopurinol.
2. It interferes with the absorption of antigout
medications.
3. It raises uric acid levels.
4. It causes the urine to become more alkaline

Answer 13

Answer: 3 Rationale: Gout is a metabolic disorder
characterized by the accumulation of uric acid in the
bloodstream or joint cavities. Alcohol increases uric
acid levels. Options 1, 2, and 4 are incorrect. Alcohol
does not cause a significant increase in drug levels of
allopurinol, does not affect the absorption of antigout
medications, and increases urine acidity.

Question 14

textbook

A patient with rheumatoid arthritis will begin treatment with adalimumab (Humira). Which statement related to this therapy is correct? Select all that apply.
Adlimumab:
1. May lower immune response and increase the
risk of infections and malignancies.
2. Is associated with osteoporosis and baseline and
periodic DXA scans should be conducted.
3. May reactivate latent TB.
4. May cause local injection-site irritations such as
pain and bruising.
5. Must be taken daily for up to 6 months.

Answer 14

Answer: 1, 3, 4 Rationale: DMARDs modify immune and
inflammatory responses but may increase the risk of
infections and malignancies, and may reactivate latent
TB. Injection site reactions such as pain, swelling, and bruising are common adverse effects. Options 2 and 5 are incorrect. Adalimumab has not been associated with an increased risk of osteoporosis and is given
subcutaneously, every other week.

Question 15

A 62-year-old female has received a prescription for alendronate (Fosamax) for treatment of osteoporosis. The
nurse would be concerned about this order if the patient
reported which condition? (Select all that apply.)
1. She enjoys milk, yogurt, and other dairy products
and tries to consume some with each meal.
2. She is unable to sit upright for prolonged periods
because of severe back pain.
3. She is lactose intolerant and rarely consumes
dairy products.
4. She has had trouble swallowing and has been told
she has “problems with her esophagus.”
5. She has a cup of green tea every night before bed.

Answer 15

Answer: 2, 3, 4 Rationale: Bisphosphonates such as alendronate require the patient to take the drug on an empty
stomach and remain upright for 30 minutes to 1 hour.
Adequate serum calcium levels should be confirmed
before starting bisphosphonates, and adequate calcium
and vitamin D intake should be encouraged while on
drug therapy. Any narrowing of the esophagus may place
the patient at risk of increased adverse esophageal effects
from the drug. Options 1 and 5 are incorrect. Adequate
calcium intake is advised while on bisphosphonates to
maintain normal serum calcium levels. The use of green
tea is not a contraindication to the use of bisphospho

Question 16

textbook

Following a surgical procedure, the patient states that
he does not want to take narcotic analgesics for pain
because he is afraid he will become addicted to the
drug. What is the best response by the nurse to the
patient’s concerns?
1. Dependence on narcotics is common among
postoperative patients but can be managed
successfully.
2. Addiction to prescription drugs is rare when used
as prescribed and according to medical protocol,
such as for pain control.
3. Older patients are more likely to become addicted.
4. Addiction is rare if the patient has a high pain
threshold.

Answer 16

Answer: 2 Rationale: Prescription drugs rarely cause
addiction when used according to accepted medical protocols. Options 1, 3, and 4 are incorrect. Older patients are not more likely to become addicted than other patients. A patient’s pain threshold does not
determine the potential for addiction. The risk of addiction for prescription medications is primarily a function
of the dose and the length of therapy.

Question 17

textbook

What is the difference between physical and psychologic dependence?
1. Physical dependence is the adaptation of the body
to a substance over time such that when the substance is withdrawn, withdrawal symptoms will
result. Psychologic dependence is the overwhelming desire to continue using a substance after it
is stopped or withdrawn but without physical
withdrawal symptoms occurring.

2. Physical and psychologic dependence are terms
   that are used interchangeably. In both cases,
   physical withdrawal symptoms will result if the
   substance is withdrawn from use.
3. They occur together: psychologic dependence is
   the first type of dependence to occur with a substance, followed by physical dependence.
4. Psychologic dependence develops when the brain
   adapts over time to the use of the substance. Physical
   dependence is the active seeking of a substance associated with a desire to continue using the substance.

Answer 17

Answer: 1 Rationale: Physical dependence and psychologic dependence may occur together and result in
drug-seeking behavior. Physical dependence occurs as
the body adapts to the substance such that withdrawal
symptoms will occur if the substance is stopped. Physical withdrawal symptoms do not occur with psychologic dependence although an intense craving for the
substance may be felt. Options 2, 3, and 4 are incorrect.
Physical and psychologic dependence are not interchangeable terms and one does not always lead to the
other. Psychologic dependence is the term associated with
the desire to continue using the drug

Question 18

A patient with diabetes reports increasing pain and
numbness in his legs. “It feels like pins and needles all
the time, especially at night.” Which drug would the
nurse expect to be prescribed for this patient?
1. Ibuprofen (Motrin)
2. Gabapentin (Neurontin)
3. Naloxone (Narcan)
4. Methadone

Answer 18

Answer: 2
Rationale: The patient is describing neuropathic pain, which is most likely to respond to the adjuvant analgesic gabapentin, an antiseizure drug used for neuropathic pain. Options 1, 3, and 4 are incorrect.
Nonopioids, such as ibuprofen, or opioids, such as
methadone are less effective at relieving pain that is
of neurologic origin. Naloxone is an opioid antagonist
and will not relieve the patient’s pain.

Question 19

chapter 18

The nurse administers morphine 4 mg IV to a patient
for treatment of severe pain. Which assessments
require immediate nursing interventions? (Select all
that apply)
1. The patient’s blood pressure is 110/70 mmHg.
2. The patient is drowsy.
3. The patient’s pain is unrelieved in 15 minutes.
4. The patient’s respiratory rate is 10 breaths per
minute.
5. The patient becomes unresponsive

Answer 19

Answer: 3, 4, 5
Rationale: Opioids may cause respiratory depression, particularly with the first dose given. The patient’s respiratory rate should remain above 12
breaths per minute. Although the patient may also become drowsy, he or she should not become unresponsive after administration of morphine sulfate. Because of the rapid onset of drugs when given IV, if
the patient’s pain is unrelieved in 15 minutes, the provider should be notified. Options 1 and 2 are incorrect.
Drowsiness is a common adverse effect of opioids, and
110/70 mmHg is within normal range for blood pressure.

Question 20

chapter 18

The nurse is caring for several patients who are receiving opioids for pain relief. Which patient is at the highest risk of developing hypotension, respiratory depression, and mental confusion?
1. A 23-year-old female, postoperative ruptured appendix
2. A 16-year-old male, post–motorcycle crash injury with lacerations
3. A 54-year-old female, post–myocardial infarction
4. An 86-year-old male, postoperative femur fracture

Answer 20

Answer: 4
Rationale: Older adult patients are at highest risk for hypotension, respiratory depression, and
increased incidence of adverse CNS effects, such as confusion. Options 1, 2, and 3 are incorrect. Most 23-yearold patients can tolerate opioids without adverse
effects. Individuals who suffer from traumatic injury
may receive narcotic analgesia. However, caution
should be taken if the individual has also experienced
any type of head injury. Opioids are often used with
individuals who suffer MI. No adverse effects such as
hypotension or respiratory depression are usually present if the dose is appropriate for the size of the patient

Question 21

chapter 33

A 24-year-old patient reports taking acetaminophen
(Tylenol) fairly regularly for headaches. The nurse
knows that a patient who consumes excessive acetaminophen per day or regularly consumes alcoholic
beverages should be observed for what adverse effect?
1. Hepatotoxicity
2. Renal damage
3. Thrombotic effects
4. Pulmonary damage

Answer 21

Answer: 1
Rationale: Excessive doses of acetaminophen
or regular consumption of alcohol may increase the risk of hepatotoxicity when acetaminophen is used. Options 2, 3, and 4 are incorrect. Nephrotoxicity or pulmonary toxicity and thrombotic events are not adverse effects associated specifically with acetaminophen

Question 22

chapter 33

The nurse is counseling a mother regarding antipyretic
choices for her 8-year-old daughter. When asked why
aspirin is not a good drug to use, what should the
nurse tell the mother?
1. It is not as good an antipyretic as is acetaminophen.
2. It may increase fever in children under age 10.
3. It may produce nausea and vomiting.
4. It increases the risk of Reye’s syndrome in
children under 19 with viral infections

Answer 22

Answer: 4
Rationale: Aspirin and salicylates are associated with an increased risk of Reye’s syndrome in children under 19, especially in the presence of viral
infections. Options 1, 2, and 3 are incorrect. Acetaminophen is not significantly different from aspirin or salicylates for the treatment of fever. Use of aspirin or salicylates should not increase fever although
it may cause nausea or vomiting related to GI irritation; however, it is not contraindicated in children specifically for this reason.

Question 23

chapter 33

A patient with a history of hypertension is to start
drug therapy for rheumatoid arthritis. Which drug(s)
would be contraindicated, or used cautiously, for this
patient? (Select all that apply.)
1. Aspirin
2. Ibuprofen (Advil, Motrin)
3. Acetaminophen (Tylenol)
4. Naproxen (Aleve)
5. Methylprednisolone (Medrol)

Answer 23

Answer: 2, 4, 5 Rationale: NSAIDs such as ibuprofen and
naproxen have been shown to increase the risk of serious
thrombotic events, MI, and stroke which can be fatal.
These drugs should be used cautiously or avoided in
patients with HTN. Corticosteroids such as methylprednisolone may cause fluid retention, which may increase the patient’s blood pressure. Cautious and frequent monitoring will be required if the patient takes this drug.
Options 1 and 3 are incorrect. Aspirin or acetaminophen
will not increase the patient’s blood pressure. Acetaminophen/paracetamol would only provide pain relief without treating the underlying inflammation associated with RA